We offer a competitive salary and benefits package, advancement opportunities and a warm, friendly work environment. We serve our patients, customers, volunteers and fellow employees with the highest ethical and professional conduct. Our warm, friendly, family of employees is what makes Hi-Desert Medical Center such a great place to work. View a list of positions available or fill out a job application on-line.

All areas of the application must be filled out completely and accurately. Please fill in the required information directly on the application and do not indicate "see resume". Please print clearly in blue or black ink.

If you have any questions about completing this application, it is important to ask the Hi-Desert medical representative who has been assisting you.

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PERSONAL DATA

First Name

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Middle Initial

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Last Name

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Present Address

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City

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State

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Zip

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Phone

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E-mail address

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Mailing Street Address (if different from above):

Mailing City (if different from above):

Mailing Zip Code (if different from above):

Other names under which you have worked

Are you over 18 years of age?

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YesNo

If under 18, can you, after employment, submit a work permit?

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YesNo

Can you, after employment, submit proof of age?

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YesNo

Have you ever been convicted of a crime (misdemeanor or felony)?

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YesNo

Conviction may not necessarily disqualify an applicant from employment.If yes, please list all convictions, giving dates, locations, and disposition of your case(s) below.

List of convictions

Have you ever been convicted of a crime as defined in 42 U.S.C. 1320a-7b?

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YesNo

If yes, please explain

Alternative contact person:

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Last Name

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Street Address

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City

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Zipcode

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Phone Number

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ALL APPLICANTS ARE SUBJECT TO PRE-EMPLOYMENT DRUG SCREENING PROCEDURES

POSITION DESIRED

First Choice

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Second Choice

Specify:

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Other:

Days And Hours

Shift Preferred

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DaysEvenings Nights

Will you work weekends?

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YesNo

Will you rotate shifts?

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YesNo

Are you able to perform the essential functions of the position for which you are applying with or without accommodation?

What personal, technical or professional skills do you bring to us, which you feel will benefit the medical center?

Personal Skills

List three persons willing to provide professional/and or character references: (Do Not List Relatives)

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Reference Occupation

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Zip Code

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Home Phone Number.

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Work Phone Number

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First Name

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Last Name

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Reference Occupation

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Street Address

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City

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State

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Zip Code

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Home Phone Number.

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Work Phone Number

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First Name

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Last Name

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Reference Occupation

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Street Address

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City

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State

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Zip Code

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Home Phone Number.

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Work Phone Number

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GOALS AND INTERESTS

Please tell us about your goals, interests, or any comments you may have relative to this application

List goals, interests or comments

EMPLOYMENT HISTORY (Resume may not be substituted for a completed application)

Are you presently employed?

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YesNo

May we contact your present employer?

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YesNo

List below your work experience for the past 10 years, beginning with the most recent, you must provide phone numbers for employers. (Use additional sheet for additional employment information.)

Give reason for gaps in employment.

Dates of Employment

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Starting Earnings

Ending Earnings

Employer Name

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Supervisor

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Job Title & Duties

Reason for leaving

Dates of Employment

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Starting Earnings 2

Ending Earnings

Employer Name

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Reason for leaving

Dates of Employment

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Starting Earnings

Ending Earnings

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Starting Earnings

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Dates of Employment

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Reason for leaving

PLEASE READ CAREFULLY, INITIAL EACH PARAGRAPH AND SIGN BELOW

I certify that I have answered all questions truthfully and have not withheld information relative to my application. I understand that any falsification, misrepresentation, or omission as well as any misleading statements or omission of the application information, attachments and supporting documents generally will result in denial of employment or immediate termination, if discovered after hire.

I Agree

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I authorize Hi-Desert Medical Center to thoroughly investigate my references, work record, education, and other matters related to my suitability for employment, and further authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I release Hi-Desert Medical Center, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities, arising out of or in any way related to such investigation or disclosure.

I Agree

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If hired, I recognize the rules and policies of Hi-Desert Medical Center, I understand that my employment and compensation can be terminated at any time, with or without cause, and with or without Notice, at the option of Hi-Desert Medical Center or myself. I understand that the Administration of Hi-Desert Medical Center has the authority to create any other terms of employment and/or to enter into any employment contract and that all such contracts must be in writing and signed by both parties. However, I also understand that unless otherwise stated in an employment contract, the company may change, withdraw or interpret other policies (including wages, hours, and working conditions) as it deems appropriate.

I Agree

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I understand and acknowledge that I will be required to submit the examining facility and to a physical examination, including drug test. Additionally, I hereby authorize the release of the results of such an examination to Hi-Desert Medical Center for their use in evaluating my suitability for employment. Further, I release the examining facility and Hi-Desert Medical Center from any and all liability, and from any damage that may result from the release of such information.

I Agree

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I also understand that all offers of employment are conditioned on the provision of satisfactory proof of an applicant's identity and legal authority to work in the United States, as well as the satisfactory completion of a post-offer medical examination.

I Agree

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By clicking on I Agree this indicates that I have read and understand the importance of supplying accurate information on the application. I am also aware of the possibility that an offer of employment being withdrawn if any of the information is not correct.

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